MANAGEMENT OF CARDIAC

DISEASE IN PREGNANCY.

PRESENTED BY DR. ADDAH

A.O.
 INTRODUCTION
Heart disease is uncommon in pregnancy.
Cardio-respiratory adaptation well tolerated by
healthy women. These changes pose a threat to
those with hearth disease.
Though uncommon, continues to be a major
cause of maternal morbidity in both developed
and developing countries.
Prognosis for pregnancy is good, if well
managed.
Multidisciplinary approach.
Classification of cardiac disease
and risk assesment.
HIGH RISK –
Eisenmenger’s complex, tetralogy of Fallot, Ebstein’s
anomaly, transposition of the great vessels.
Pulmonary hypertension, Ischaemic heart disease, heart
failure.
MODERATE RISK.
Valvular stenosis, coarctation of the aorta, Hx of
myocardial infarction, Marfan syndrome, mechanical
prosthetic valve.
Low Risk-
Acyanotic heart disease, mild- moderate valvular
regurgitation, small VSD, Small ASD.
 PRECOCEPTION
EVALUATION
Preconception counselling.
Cardiac HX.
Functional status.
CVS Examination.
Ventricular Reserve.
Suspected Valvular or congenital heart disease- Doppler
echocardiography.
Pulmonary artery pressure.
Arrythmia risk
Pacemaker or defribilation function.
Dental hygiene.
ABSOLUTE CONTRAIDICATIONS TO PREGNANCY-
Pulmonary hypertension, Eisenmenger syndrome, severe mitral
stenosis, Pul. hyprtension + ASD, VSD, PDA, CYANOTIC
HEART DISEASE, Marfan syndrome.
PRE- Existing Heart Disease.
Evaluate prior diagnostic results +
intervention.
Evaluate current medications.
 MANAGEMENT OF HEART
DISEASE IN PREGNANCY.
Detect subtle changes in maternal wellbeing –
symptoms
Dyspnoea at rest.
Substantial palpitations at rest or with other
symptoms.
Orthopnoea
Paroxysmal nocturnal dyspnoea
Exertional syncope, angina
Chest pain at rest.
 CVS EXAMINATION
Evidence of pulmonary hypertension.
Cyanosis
Jugular venous distension.
Persistent rales
Cardiomegaly
Loud P2, wide split of S2
Loud systolic murmur
Clubbing
Peripheral oedema
Increased fluid retention
Bradyarrhythmia
Tachyarrhythmia.
Blood pressure
Pulse rate + rhythm
Jugular venous pressure
Presence of basal crepitations.
Ankle + sacral oedema
 CVS DIAGNOSTIC TESTING
DURING PREGNANCY.
Resting ECG may change in normal
pregnancy.
If arrhythmia not detected on a 12 lead
ECG do 24- 48 hr ECG.
ECG stress test.
Echocardiography.
Cardiac catheterisation + angiograohy.
MRI
FURTHER MANAGEMENT.
Outpatient mgt in most cases as patients remain well.
Advice patient to reduce physical activities.
Look for risk factors that would precipitate heart failure.
Advice against smoking’
Prophylactic antibiotic for dental work, PROM, Prosthetic
heart valves
Termination of pregnancy is not medically advised
unless in conditions stated above.
Deteriorating cardiac status- admit .
Add anticoagulants in those with congenital heart
disease.
 TREATMENT OF HEART
FAILURE IN PREGNANCY.
Admit to hospital
Confirm diagnosis.
Drug therapy – Digoxin.
Diuretic esp. if there is pulmonary
oedema.
Oxygen PRN.
Rx dysrrhymias with B- blockade
Correct anaemia if present.
Nurse in cardiac position.
 MANAGEMENT OF
LABOUR/DELIVERY.
Aim for vaginal delivery.
Induction of labour indicated for only obstetric reasons.
Low risk of heart failure if cardiac reserve is good.
Adequate analgesia – epidural
Control IV fluids.
Avoid autocaval compression.
Shorten 2ND stage labour.
Avoid Ergometrine
Avoid caesarian section in presence of heart failure.
Oxygen should be readily available
Avoid B- sympathomimetic drugs.
 FAMILY PLANNING
Avoid COC’s
IUCD – give prophylactic antibiotics during
insertion.